NHCAA distributed the Association's 2018 Year-in-Review highlighting the past year's successes and accomplishments, confirming once again that the Association provides our members, partners, and the industry with a range of effective resources to improve and strengthen the fight against health care fraud.

NHCAA recently published its biennial benchmarking survey, the Anti-Fraud Management Survey for Calendar Year 2017. The full Survey Report is accessible only to Member Organizations and Law Enforcement Liaisons.

NHCAA has published a new white paper that examines the scope of responsibility of health insurer special investigations units and how they calculate return on investment within their organizations. NHCAA’s biennial Anti-Fraud Management Survey reports on SIU outcomes, which have historically been combined to calculate SIU return on investment. This new paper provides insight about the challenges in measuring SIU ROI while demonstrating the value SIUs bring to their organizations.

The Healthcare Fraud Prevention Partnership (HFPP) is constantly looking for ways to use the power of our combined resources to educate, inform, and improve our partners’ efforts to detect and prevent fraud, waste and abuse. The HFPP creates white papers to inform the public about pertinent issues that impact payers, providers, and patients.

The Centers for Medicare and Medicaid Services (CMS) has proposed significant changes to how medical loss ratio is calculated and reported for Medicare Advantage and Part D plans. If made final, the rule would expand the definition of Quality Improvement Activities (QIA) to include fraud reduction activities, including fraud prevention, fraud detection, and fraud recovery. NHCAA submitted a letter of support.